Cetacaine is a topical anesthetic that contains the active ingredients

benzocaine Benzocaine, sold under the brand name Orajel amongst others, is a local anesthetic, belonging to the amino ester drug class, commonly used as a topical painkiller or in cough drops. It is the active ingredient in many over-the-counter ...

(14%), butamben (2%), and

tetracaine Tetracaine, also known as amethocaine, is an ester local anesthetic used to numb the eyes, nose, or throat. It may also be applied to the skin before starting intravenous therapy to decrease pain from the procedure. Typically it is applied as a l ...

hydrochloride (2%). Cetacaine also contains small amounts of

benzalkonium chloride Benzalkonium chloride (BZK, BKC, BAK, BAC), also known as alkyldimethylbenzylammonium chloride (ADBAC) is a type of cationic surfactant. It is an organic salt classified as a quaternary ammonium compound. ADBACs have three main categories of use: ...

at 0.5% and 0.005% of cetyl dimethyl ethyl ammonium bromide all in a bland water-soluble base. Although Cetacaine has been widely used in the medical and dental fields, it has yet to be officially approved by the

FDA The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

. Cetacaine is produced by the company Cetylite Industries, Inc. and they provide Cetacaine in three forms: liquid, gel, and spray.

Medical uses

Cetacaine is a

-based

anesthetic An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into t ...

that also contains other active ingredients that include butamben and

hydrochloride. The main use for this drug is to produce anesthesia to

mucous membrane A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It ...

s to numb and help control the pain in that area. The spray form of Cetacaine is also used to help prevent gagging in the patient. The anesthetic effect of Cetacaine can be expected to take effect in about 30 seconds and last between 30–60 minutes depending on location and application amount. Cetacaine can and has been used for surgeries that include bronchi, ear, esophagus, larynx, mouth, nose, pharynx, rectal, and vaginal procedures. These procedures can include periodontal treatment, pre-probing, pre-scaling/root planning procedures, pre-injection, and laser dentistry.

Available forms

The dosage should be applied directly to the site where

anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

is required. The dosage should be modified according to the patient and there has not been a dosage specified for children. Spray: Cetacaine spray should be applied for only one second and dosage should not exceed an application spray longer than 2 seconds. Gel: Use a cotton swab to apply 200 mg to the needed area and the dosage should not exceed 400 mg. Liquid: Apply 200 mg either directly or by using cotton applicator to the location and the dosage should not exceed 400 mg.

Adverse effects

Cetacaine has been known to cause adverse effects in the patients it has been administered to. These include

hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) is an abnormal physiological condition in which there is an undesirable and adverse immune response to an antigen. It is an abnormality in the immune system that causes Imm ...

in the form of anaphylaxis, dermatitis, erythema, pruritus which can lead to oozing and vesiculation. There have also been accounts of rashes, edema, urticarial and other allergic symptoms as well as methemoglobinemia. Other adverse effects can include: tremors, twitching, dizziness, confusion, hypo-tension, vomiting, euphoria, and blurred or double vision.

Pregnancy and breastfeeding

It has not been determined of Cetacaine has any adverse defects on the formation of the fetus or if it is transferred through breastfeeding. It is recommended that professional advise should be taken in these regards.

Pharmacology

Mechanism of action

Cetacaine acts quickly in about 30 seconds and can last between 30–60 minutes. This is due to benzocaine causing the immediate anesthetic effect, while butamben and tetracaine hydrochloride causes the extended effect of Cetacaine. The actual mechanism for the onset of anesthesia is unknown, but it is believed that the active ingredients reversibly block nerve conduction therefore causing the numbing sensation. This stabilizes the neuron and prevents signals from being transferred.

Pharmacokinetics

The rate of absorption through the skin and after diffusing in and back out of the

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons). Nerves have historically been considered the basic units of the peripheral nervous system. A nerve provides a common pathway for the Electrochemistry, electrochemical nerv ...

membrane it is metabolized by plasma

cholinesterase The enzyme cholinesterase (EC 3.1.1.8, choline esterase; systematic name acylcholine acylhydrolase) catalyses the hydrolysis of choline-based esters: : an acylcholine + H2O = choline + a carboxylate Several of these serve as neurotransmitte ...

and then excreted in urine.

Contraindications

This product should not be used to cover a large area for anesthetic affect causing an adverse reaction. The liquid and other forms of Cetacaine should not be administered via injection or used under dentures, on eyes or with patients with a cholinesterase deficiency.

Interactions

Cetacaine can have interaction with other drugs being taken by patients one of the interactions that can lead to

methemoglobinemia Methemoglobinemia, or methaemoglobinaemia, is a condition of elevated methemoglobin in the blood. Symptoms may include headache, dizziness, shortness of breath, nausea, poor muscle coordination, and blue-colored skin (cyanosis). Complications ma ...

is the interaction with sodium nitrate as well as prilocaine, which can lead to severe illness or death. As well as others listed on the referenced site.

History

The marketing start date for Cetacaine was January 1, 1960, but benzocaine was first produced in 1890 by German scientist 1890 by Eduard Ritsert. Cetacaine is mainly used in the dental field but has seen use as well in the medical field when dealing with small surgeries on or around mucous membranes. Benzocaine-based anesthetics (which includes Cetacaine) have started to come scrutiny by the FDA. In 2006 the FDA has announced that benzocaine-based anesthetics can cause methemoglobinemia and with that listed warnings and precautions to take when dealing with benzocaine based drugs. The FDA also during this time started to take many Benzocaine based drugs that were not approved off the market and fining those companies they were under.

Research

From looking at the patent bank the only research that has occurred around Cetacaine has been with certain medical procedures that use Cetacaine as an anesthetic or new dispensing containers or methods. One of the only studies that are current with Cetacaine is the one that the FDA is conducting surrounding the issue of patients contracting methemoglobinemia from the use of Cetacaine. In these studies it was recorded that 319 cases were reported and out of the 319, 32 were considered life-threatening and 3 cases resulted in death.

Economics

Cost effectiveness

Cetacaine has been used in the medical and dental field for a long time now. Its main competitors have been benzocaine and other benzocaine-based drugs. The use of Cetacaine has allowed for faster in and out times for patients, cheaper costs, easier use for the doctors or dentists needing to apply an anesthetic and better patient compliance (less anxiety). Cetacaine compared to some of the leading competitors is considered by most a cheaper option. For the spray option the bottle containing 56g can dispense 100 doses and only cost the dentist $0.79 per dose. The liquid Cetacaine that comes in the 30 g bottle can dose 73 full mouths at a cost of about $0.75 per dose.

Manufacturer

The company the makes Cetacaine is called Cetylite Industries, Inc. This company is based out of Pennsauken, NJ and has a total of 75 employees. Zoom Company Information, Cetylite, November 2015. Cetylite brings in total revenue of around $7,500,000 with their main product being the topical anesthetics, and infection prevention products.

References

{{Reflist Combination drugs Local anesthetics